<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>Title</title>
    <script src="/js/config.js"></script>
</head>
<body>
<form class="layui-form" lay-filter="roleForm" id="add_bli_form" action="" style="padding:15px 10px;">
    <input type="hidden" name="id">
    <div class="layui-form-item">
        <label class="layui-form-label">病历号</label>
        <div class="layui-input-block">

            <input type="text" name="disoddid" required  lay-verify="required" placeholder="请输入标题" autocomplete="off"class="layui-input"  >

        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">患者</label>
        <div class="layui-input-block">
            <input type="text" name="rname" required  lay-verify="required" placeholder="请输入标题" autocomplete="off" class="layui-input">

        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">时间</label>
        <div class="layui-input-block">
            <input type="date" name="retime" required  lay-verify="required" placeholder="请输入标题" autocomplete="off" class="layui-input">

        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">疾病</label>
        <div class="layui-input-block">
            <input type="text" name="illid" required  lay-verify="required" placeholder="请输入标题" autocomplete="off" class="layui-input">

        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">复查</label>
            <div class="layui-input-block">
                <input type="radio" name="operation" value="是" title="是">
                <input type="radio" name="operation" value="否" title="否" checked>
            </div>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">告诉</label>
        <div class="layui-input-block">

            <textarea name="casetell" placeholder="请输入内容" class="layui-textarea"></textarea>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">检查</label>
            <div class="layui-input-block">
                <textarea name="chati" placeholder="请输入内容" class="layui-textarea"></textarea>
            </div>
    </div>
    </div>
    <script>
        layui.form.render();

    </script>
</form>
</body>
</html>